1. The Nursing Process
Dr. Abdalkarim Radwan

2. Resources
Andrea Ackermann, Mount St. Mary College, Critical-thinking-the-nursing-process 2001.
Sara-jo Wiscombe, Nursing Process ,Wallace Community College ,May 22,2001.
Tucker C, MODULE A INTRODUCTION TO NURSING Process, August 21,
Dr. Abdalkarim Radwan

3. Dr. Abdalkarim Radwan

4. The Nursing Process
An organizational framework for the practice of nursing
Orderly, systematic
Central to all nursing care
Encompasses all steps taken by the nurse in caring for a patient
Dr. Abdalkarim Radwan

5. Definition of the Nursing Process
An organized sequence of problem-solving steps used to identify and to manage the health problems of clients
It is accepted for clinical practice established by the American Nurses Association
Dr. Abdalkarim Radwan

6. Benefits of Nursing Process
Provides an orderly & systematic method for planning & providing care
Enhances nursing efficiency by standardizing nursing practice
Facilitates documentation of care
Provides a unity of language for the nursing profession
Is economical
Stresses the independent function of nurses
Increases care quality through the use of deliberate actions
Dr. Abdalkarim Radwan

7. The Nursing Process Utilizes The Following
Assessment
Nursing Diagnosis
Planning
Implementation
Evaluation
Dr. Abdalkarim Radwan

8. Characteristics of the Nursing Process
Within the legal scope of nursing
Based on knowledge-requiring critical thinking
Planned-organized and systematic
Client-centered
Goal-directed
Prioritized
Dynamic
Dr. Abdalkarim Radwan

9. Benefits of using the nursing process
Continuity of care
Prevention of duplication
Individualized care
Standards of care
Increased client participation
Collaboration of care
Dr. Abdalkarim Radwan

10. Being Accountable Using critical thinking before taking actions
Being responsible for your actions
Entering the professional role
Working at the level of your peers
Using the nursing process
Dr. Abdalkarim Radwan

11. Something to think about:
Nurses are responsible for a unique dimension of healthcare – “ the diagnosis and treatment of human responses to actual or potential health problems”
Dr. Abdalkarim Radwan

12. MARTHA ROGERS, NURSE THEORIST
“When an apple is cut, others see seeds in the apple. We, as nurses, see apples in the seeds.”
Dr. Abdalkarim Radwan

13. What Are Your Responsibilities?
Recognize health problems.
Anticipate complications.
Initiate actions to ensure appropriate and timely treatment.
Begin to think CRITICALLY !!!!!!
Dr. Abdalkarim Radwan

14. Critical Thinking MENTAL OPERATIONS –decision making & reasoning
KNOWLEDGE-having the facts & understanding the reason behind the knowledge
ATTITUDES- curious/open-minded/non-judgmental….
Dr. Abdalkarim Radwan

15. Critical thinking is careful, deliberate, and goal directed.
Critical thinking in nursing is an essential component of professional accountability and quality nursing care.
Critical thinking is careful, deliberate, and goal directed.
Dr. Abdalkarim Radwan

16. Assessment of Well-Being
According to the World Health Organization is well-being in these domains:
Emotional
Physical
Social
Spiritual
Dr. Abdalkarim Radwan

17. Lets Get Started : Nurse collects background info from previous charts
Ensure environment is conducive
Arrange seating
Allow adequate time
Nurse introduces self
Identifies purpose of interview
Ensure confidentiality of information
Provide for patient needs before starting
Dr. Abdalkarim Radwan

18. TYPES OF INTERVIEWS DIRECTED NON-DIRECTED
THINGS THAT IMPAIR COMMUNICATION:
PRESENTING QUICK SOLUTIONS
UNWARRANTED CHEERFULNESS
FALSE REASSURANCE
GIVING ADVICE
CHANGING THE SUBJECT
Dr. Abdalkarim Radwan

19. ASSESSMENT Observation Interview Examination Types of questions
Environment (physical and emotional) Spiritual conciderations
Examination
Dr. Abdalkarim Radwan

20. Types of Data To Collect:
Objective data-observable and measurable facts (Signs)
Subjective data-information that only the client feels and can describe (Symptoms)
Dr. Abdalkarim Radwan

21. CULTURAL DIVERSITY
MUST PROVIDE CARE CONGRUENT WITH A CLIENT’S EXPECTATIONS
“This is not about you” ?
Respect INDIVIDUAL’S DIFFERENCES, What is the significance of the problem or illness to the client?
What does it mean in the family/community?
Dr. Abdalkarim Radwan

22. COMMON Challenges: Defense Mechanisms
COMPENSATION
DENIAL
DISPLACEMENT
RATIONALIZATION
PROJECTION
REPRESSION
SUPPRESSION
REGRESSION
Dr. Abdalkarim Radwan

23. Continued
THE NURSING PROCESS HELPS NURSES UNDERSTAND THE STRATEGIES CLIENTS USE IN their attempt at coping:
This knowledge will help you FURTHER INDIVIDUALIZE THEIR CARE
Dr. Abdalkarim Radwan

24. Resources Client Other individuals Previous records Consultations
Diagnostics studies
Relevant literature
Dr. Abdalkarim Radwan

25. Assessment
Data base assessment – comprehensive information you gather on initial contact with the person to assess all aspects of health status.
Focus assessment – the data you gather to determine the status of a specific condition.
Dr. Abdalkarim Radwan

26. Sources of Data Primary source: Client
Secondary source: Client’s family, reports, test results, information in current and past medical records, and discussions with other health care workers
Dr. Abdalkarim Radwan

27. Disease Prevention
Primary prevention – protection from a disease while still in a healthy state.
Secondary prevention – early detection and treatment of disease.
Tertiary prevention – prevent complications and to maintain health once the disease process has occurred.
Dr. Abdalkarim Radwan

28. Verifying Data Essential in critical thinking!!!!! Measurable data
Double check personal observations
Double check equipment
Check with experts and team members
Recheck out-liers
Compare objective and subjective data
Clarify statements
Dr. Abdalkarim Radwan

29. Planning Establish the goals, interventions and outcomes
Dr. Abdalkarim Radwan

30. General Guidelines for Setting Priorities
Take care of immediate life-threatening issues.
Safety issues.
Patient-identified issues.
Nurse-identified priorities based on the overall picture, the patient as a whole person, and availability of time and resources.
Dr. Abdalkarim Radwan

31. Nurse Identified Priorities
Composite of all patient’s strengths and health concerns.
Moral and ethical issues.
Time, resources, and setting.
Hierarchy of needs.
Interdisciplinary planning.
Dr. Abdalkarim Radwan

32. Identifying Client-centered Outcomes
State what the patient will do or experience at the completion of care.
Give direction to the patient’s overall care.
Patient behaviors not nurse behaviors!!
“The patient will…”
Dr. Abdalkarim Radwan

33. DIAGNOSIS Sort, cluster, analyze information
Identify potential problems and strengths
Write statement of problem or strength
Risk of infection related to compromised nutrition
Dr. Abdalkarim Radwan

34. Nursing Diagnosis (cont.)
Potential for effective breastfeeding related to knowledge level and support system
Prioritize the problems
Not a medical diagnosis
Dr. Abdalkarim Radwan

35. Steps for deriving outcomes from Nursing Diagnosis
Look at the first clause of the nursing dx and restate in a statement that describes improvement, control or absence of the problem.
Risk for infection r/t surgical procedure.
The client will demonstrate no signs or symptoms of infection.
Dr. Abdalkarim Radwan

36. Components of Outcomes
Subject: who is the person expected to achieve the outcome?
Verb: what actions must the person take to achieve the outcome?
Condition: under what circumstances is the person to perform the actions?
Performance criteria: how well is the person to perform the actions?
Target time: by when is the person expected to be able to perform the actions?
Dr. Abdalkarim Radwan

37. Nursing Interventions
Road maps directing the best ways to provide nursing care.
Evidence based nursing.
Monitor health status.
Minimize risks.
Resolve or control a problem.
Assist with ADLs.
Promote optimum health and independence.
Dr. Abdalkarim Radwan

38. Interventions
Direct interventions: actions performed through interaction with clients.
Indirect interventions: actions performed away from the client, on behalf of a client or group of clients.
Dr. Abdalkarim Radwan

39. Nursing Diagnosis
Health issue that can be prevented, reduced, resolved, or enhanced through independent nursing measures
Dr. Abdalkarim Radwan

40. Documenting the Plan of Care
To ensure continuity of care, the plan must be written and shared with all health care personnel caring for the client.
Consists of:
Prioritized nursing diagnostic statements.
Outcomes.
Interventions.
Dr. Abdalkarim Radwan

41. Documentation Clear and concise Appropriate terminology
Usually on a designated form
Physical assessment
Usually by Review of Systems
Overview of symptoms
Diet
Each body system
Dr. Abdalkarim Radwan

42. Documentation
Use patient’s own words in subjective data – enclose in “ ___” (quotation marks)
Avoid generalizations – be specific
Don’t make summative statements – describe - e.g. patient is being ornery should be patient resists instruction or patient states “Don’t talk to me, I don’t care about that”
Dr. Abdalkarim Radwan

43. Evaluation Determining outcome achievement
Identifying the variables affecting outcome achievement
Deciding whether to continue, modify, or terminate the plan
Dr. Abdalkarim Radwan

44. Determining Outcome Achievement
Must be aware of outcomes set for the client.
Must be sure patient is ready for evaluation.
Is patient able to meet outcome criteria?
Is it:
Completely met?
Partially met?
Not met at all?
Record in progress in notes.
Update care plan.
Dr. Abdalkarim Radwan

45. Identifying Variable Affecting Outcome Achievement
Maintain individuality of care plan:
1. Is the plan realistic for the client?
2. Is the plan appropriate at the time for this particular client?
3. Were changes made in the plan when needed?
4. How does the client feel about the plan?
Dr. Abdalkarim Radwan

46. Predict, Prevent, and Manage
Focus on early intervention
Based on research
Predict and anticipate problems
Look for risk factors
Dr. Abdalkarim Radwan

47. Diagnostic Statements
Name of the health-related issue or problem as identified in the NANDA list
Etiology (its cause)
Signs and Symptoms
The name of the nursing diagnosis is linked to the etiology with the phrase “related to,” and the signs and symptoms are identified with the phrase “as manifested (or evidenced) by”
Dr. Abdalkarim Radwan

48. Collaborative Problems-Nurse’s Responsibility
Correlating medical diagnoses or medical treatment measures with the risk for unique complications
Documenting the complications for which clients are at risk
Making pertinent assessments to detect complications
Dr. Abdalkarim Radwan

49. Continued Reporting trends that suggest development of complications
Managing the emerging problem with nurse- and physician-prescribed measures
Evaluating the outcomes
Dr. Abdalkarim Radwan

50. The Nursing Process Nursing Diagnosis
Judgment or conclusion about the risk for—or actual—need/problem of the patient
NANDA format
Dr. Abdalkarim Radwan

51. NANDA – North American Nursing Diagnosis Association
Identifies nursing functions
Creates classification system
Establishes diagnostic labels
Risk of infection related to compromised nutritional state
Potential complication of seizure disorder related to medication compliance
Dr. Abdalkarim Radwan

52. Planning
The process of prioritizing nursing diagnoses and collaborative problems, identifying measurable goals or outcomes, selecting appropriate interventions, and documenting the plan of care.
The nurse consults with the client while developing and revising the plan.
Dr. Abdalkarim Radwan

53. Setting Priorities Determine problems that require immediate action
Maslow’s Hierarchy of Human Needs
Dr. Abdalkarim Radwan

54. Short-Term Goals Outcomes achievable in a few days or 1 week
Developed form the problem portion of the diagnostic statement
Client-centered
Measurable
Realistic
Accompanied by a target date
Dr. Abdalkarim Radwan

55. Long-Term Goals
Desirable outcomes that take weeks or months to accomplish for client’s with chronic health problems
Dr. Abdalkarim Radwan

56. The Nursing Process Planning
Identification of goals and outcome criteria
Prioritization
Time frame
Dr. Abdalkarim Radwan

57. Selecting Nursing Interventions
Planning the measures that the client and nurse will use to accomplish identified goals involves critical thinking.
Nursing interventions are directed at eliminating the etiologies.
Dr. Abdalkarim Radwan

58. Selecting an intervention
The nurse selects strategies based on the knowledge that certain nursing actions produce desired effects.
Nursing interventions must be safe, within the legal scope of nursing practice, and compatible with medical orders.
Dr. Abdalkarim Radwan

59. Communicating The Plan
The nurse shares the plan of care with nursing team members, the client, and client’s family.
The plan is a permanent part of the record.
Dr. Abdalkarim Radwan

60. Evaluation
The way nurses determine whether a client has reached a goal.
It is the analysis of the client’s response, evaluation helps to determine the effectiveness of nursing care.
Dr. Abdalkarim Radwan

61. The Nursing Process Evaluation Ongoing part of the nursing process
Determining the status of the goals and outcomes of care
Monitoring the patient’s response to drug therapy
Dr. Abdalkarim Radwan

62. Documentation Clear and concise Appropriate terminology
Usually on a designated form
Physical assessment
Usually by Review of Systems
Overview of symptoms
Diet
Each body system
Dr. Abdalkarim Radwan